Continuous external subdural drainage in the management of infantile subdural collections: a prospective study

Abstract

Continuous external subdural drainage (CESD) was suggested as a treatment step to be inserted prior to SP shunting, primarily because it makes it possible to avoid shunt placement in a significant number of patients. Thirty-three patients with symptomatic chronic subdural collection confirmed by computed tomography were included in this study. Unilateral CESD was performed in all cases, using a lumbar drainage set. The drains were left in place for no more than 10 days. A subduroperitoneal (SP) shunt was inserted in those patients in whom re-accumulation of the subdural collection had occurred. Of 33 patients, 17 were definitively treated by CESD and 16 subsequently needed an SP shunt. The cost of treatment with CESD was just less than half the cost of treatment with SP shunting. CESD can be used as a step before SP shunting in the management of chronic infantile subdural collections, since it is effective without further treatment in half the patients and safer than subdural tapping.

Long-term external drainage for subdural collections in infants

“…During the last decade, several authors have published their experiences of it [3,4,5,8]. Although technical details, duration of ED, and criteria for recourse to subduro-peritoneal shunting vary, it appears that ED is a safe method, obviating the need for a permanent shunt at least in an important percentage of patients.…”

“…Of the 16 children treated by Gaskill [5], ED proved to be the definitive therapy in 9. In the prospective study by Ersahin et al, [4], who used ED for a maximum of 10 days and defined the need for subduro-peritoneal shunting based on a CT scan at 2 weeks, 16 of 33 patients subsequently needed a permanent shunt. Using our guidelines, described in the Methods section, we 431 tibiotics and insertion of a new catheter and was cured without sequelae.…”

“…In many centers a permanent subduro-peritoneal shunt is implanted at the time of diagnosis. Some authors have demonstrated that external drainage for a relatively short period can avoid a shunt in about 50% [4,5]. We have prospectively treated 31 infants with chronic subdural collections, using guidelines for removing the drains and allowing long-term drainage in selected cases.…”

Minicraniotomy versus bur holes for evacuation of chronic subdural collections in infants—a preliminary single-institution experience

“…Failure rates vary widely, from 6% to 48%, with one paper reporting an infection rate of 8%. 4,7,9,16,17,27 Bur hole evacuation is slightly more invasive but is also straightforward. It requires general anesthesia and allows the surgeon to irrigate the subdural space and leave a drain in place if necessary; however, it still has the disadvantage of limited exposure and thus a relative inability to deal adequately with loculated collections.…”

Subdural Fluid Collections in Infants

“…As generally accepted, we also favor subduroperitoneal (SP) shunting as a definitive mode of treatment in the management of infantile subdural fluid collections. No infection has been reported in patients in whom continuous external subdural drainage had been used [2][3][4], except for the article cited in their paper [5].Van Calenbergh et al [4] used a longer period of external subdural drainage in their patients and only 4 of 31 patients needed SP shunting. I would like to comment on the removal of SP shunts.…”